Basic Information
| Provider Information | |||||||||
| NPI: | 1891064713 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTLINE THERAPIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7400 CENTER AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926473094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142922322 | ||||||||
| FaxNumber: | 7148664153 | ||||||||
| Practice Location | |||||||||
| Address1: | 7400 CENTER AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926473094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142922322 | ||||||||
| FaxNumber: | 7148664153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2011 | ||||||||
| LastUpdateDate: | 12/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | VESCIAL | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SPEECH THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 7142922322 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MS CCC/SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP9675 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.